Home Health Providers Nabbed in Historic, $712 Million Fraud Takedown

By Emily Study | June 18, 2015

In an action that’s been deemed the “largest criminal health care fraud takedown” in the Department of Justice’s history, 243 individuals — including home health care providers — have been charged for their participation in schemes involving approximately $712 million in false billings.

The defendants are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft, the DOJ announced Thursday.

The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and pharmacy fraud. One of the alleged home health conspiracies took place in the Dallas-Forth Worth area between 2009 and 2013, according to charges. It involved more than $40 million in fraudulent Medicare payments, due to overbilling for physician home visits and other practices, the authorities contend.

“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement,” said Attorney General Loretta E. Lynch, in a statement. “The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”

In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators allegedly were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.

Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $712 million in fraudulent billing, the DOJ reports.

“Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries,” said Inspector General Daniel R. Levinson of the Health and Human Services Office of Inspector General (HHS-OIG). “This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets. Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.”